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首页> 外文期刊>Academic Medicine: Journal of the Association of American Medical Colleges >Using SNAPPS to facilitate the expression of clinical reasoning and uncertainties: a randomized comparison group trial.
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Using SNAPPS to facilitate the expression of clinical reasoning and uncertainties: a randomized comparison group trial.

机译：使用SNAPPS来促进临床推理和不确定性的表达：随机比较组试验。

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PURPOSE: When medical students present cases to preceptors, they focus mainly on factual information and reveal little about their diagnostic reasoning or uncertainties. Do third-year students using the six-step, learner-centered SNAPPS technique (Summarize history and findings, Narrow the differential; Analyze the differential; Probe preceptor about uncertainties; Plan management; Select case-related issues for self-study) for case presentations to family medicine ambulatory care preceptors express clinical reasoning and learning issues more than students not trained in the technique? METHOD: The authors conducted a posttest-only, comparison groups, randomized trial in 2004-2005 with 64 students in three groups: SNAPPS training, feedback training (controlling for training time), and usual-and-customary instruction. SNAPPS training combined brief faculty development with more extensive learner development followed by practice during a four-week family medicine rotation. During the last week, students audiotaped case presentations, which the authors coded for 10 dependent variables organized into six outcome categories that measure expression of clinical diagnostic reasoning and learning issues. RESULTS: The authors coded 66 SNAPPS, 67 comparison, and 82 usual-and-customary case presentations. Students in the SNAPPS group outperformed students in comparison and usual-and-customary groups for each outcome category. SNAPPS presentations were no longer than usual presentations but were one minute longer than those of the comparison group. CONCLUSIONS: SNAPPS greatly facilitates and enhances expression of diagnostic reasoning and uncertainties during case presentations to ambulatory care preceptors. Students can conduct case presentations using a technique that makes each step explicit and gives learners, rather than preceptors, the responsibility for expressing their clinical reasoning and uncertainties.
机译：目的：当医学生向患者介绍病例时，他们主要关注事实信息，而很少透露其诊断依据或不确定性。三年级学生是否使用以学习者为中心的六步学习法（总结历史和发现，缩小差异;分析差异;探究不确定性的先兆;计划管理;选择与案例相关的问题进行自学）向家庭医学门诊监护人的演讲比没有接受过该技术培训的学生更能表达临床推理和学习问题？方法：作者在2004年至2005年进行了仅限后测的比较组随机试验，分为64组，分为三组：SNAPPS培训，反馈培训（控制培训时间）和常规指导。 SNAPPS培训将简短的教师发展与更广泛的学习者发展相结合，然后在为期四周的家庭医学轮训中进行实践。在上个星期，学生为案例录音，作者将10个因变量编码成6个结果类别，以衡量临床诊断推理和学习问题的表达。结果：作者编写了66个SNAPPS，67个比较和82个常规案例的编码。在每个结局类别中，SNAPPS组的学生在比较组和普通组和常规组中的表现均优于学生。 SNAPPS演示不再比通常的演示要长，但比对照组的演示时间要长一分钟。结论：SNAPPS极大地促进和增强了向门诊护理人员进行病例介绍期间诊断推理和不确定性的表达。学生可以使用一种技术来进行案例演示，该技术可以使每个步骤都清晰明了，并赋予学习者（而不是导师）表达其临床推理和不确定性的责任。

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